In recent years, there has been substantial interest in the development and application of minimally invasive surgical techniques. Minimally invasive surgical techniques have become increasingly popular because tissue damage from such techniques is minimal and the recovery time for patients undergoing such procedures is typically shorter than for procedures performed by conventional surgical techniques. For example, laparoscopic surgery techniques have made it possible to access to organs in the peritoneal cavity without the necessity of creating huge incision in the abdominal wall. Instead, far smaller and less invasive incisions in the abdominal wall are required when laparoscopic techniques are used. These much smaller and less invasive incisions enable patients to be discharged more quickly with less trauma and more cosmetically appealing results.
Substantial advancements are now underway to provide surgical access to the peritoneal cavity without providing any incision in the abdominal wall. This new technique, sometimes referred to as Natural Orifice Transluminal Endoscopic Surgery (also known by the acronym in a thing of beauty to you soon “NOTES”), provides access to organs located in the peritoneal cavity through a natural orifice of the body, as for example through the colon, throat or the vagina. This technique leaves no visible scars and minimizes post operative pain. In employing this technique, an endoscope is passed through a natural orifice of the body, such as the mouth or anus, and the endoscope is extended into a selected area of the digestive tract, such as the stomach or colon, that is proximally located relative to the abdominal structure of interest. An incision is then made in wall of the stomach or colon, and the endoscope is then passed through the incision to perform diagnostic or therapeutic interventions on a structure of interest located in the peritoneal cavity.
One potential problem with accessing the peritoneal cavity through the digestive system is the possibility of carrying contaminants from the digestive tract into the peritoneal cavity, either directly or on the instruments that are inserted through the luminal incision in the wall of the colon or stomach. It is, of course, highly desirable to avoid contamination of the peritoneal cavity, and to perform the diagnostic or therapeutic procedure in a sterile field. One method of reducing the risk of contamination is to use an overtube, that is, a tubular member positioned on the outside of the endoscope through which the endoscope is slidably movable. An open end of the overtube is secured to wall of the stomach or colon, and a luminal incision is performed inside the area defined by the overtube. The walls of the overtube then function to isolate the area in which the luminal incision is made from the remainder of the digestive tract. With the end of the overtube secured to the wall of the digestive tract, an endoscope is then extended through the end of the overtube and into the peritoneal cavity through the luminal insertion. With the endoscope inserted into the peritoneal cavity, operational instruments are then passed through a working channel in the endoscope to access to an organ of interest located in the peritoneal cavity upon which a diagnostic or therapeutic intervention is desired. One way of securing the end of the overtube to the wall of the stomach or colon is through the use of a vacuum. Unfortunately, securing the end of an overtube to the wall of a stomach or colon with a vacuum is not always fully reliable. The stomach wall, for example, is very flexible, and the seal between the end of the overtube and the stomach wall is easily lost whenever the stomach flexes or otherwise moves. When the seal between the end of the overtube and the stomach wall is lost, the luminal incision is no longer isolated from the remaining areas of the digestive track, and the passage of contamination through the luminal incision into the peritoneal cavity may occur. As a consequence, the sterility of the field in the peritoneal cavity in which the diagnostic or therapeutic intervention is occurring is compromised.
In addition to introducing contamination into the peritoneal cavity while the surgical intervention is being performed, substantial problems arise in connection with preventing contamination from entering the peritoneal cavity during and after removal of the endoscope and closure of the incision. In addition, closing gastric lumen incisions is frequently either time-consuming or very difficult, or both. For example, many clip appliers or capable of inserting only a single clip at a time, and the applier must be pulled out of the surgical slight and reloaded after each clip is inserted.